| NPI | 1851980122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA DDS112384) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WA 61108490) |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2025-11-11 |